Invisalign® has been around for a few years now and has proven to be a very effective solution for straightening teeth.

However, it does not take the place of all orthodontics by any means. There are many outcomes for optimal straightening of the teeth that can’t be accomplished with Invisalign®, in which case traditional orthodontics are the better option. Fortunately, for the great majority of people who once had orthodontics and it has relapsed, Invisalign® is an ideal procedure to get the teeth straight again. There are many situations where Invisalign® can get excellent results, even for someone who has not had orthodontics before.

In order to utilize Invisalign®, it is vital that the dentist has a full understanding of occlusion and the patient’s TMJ (joint of the jaw) health. Training in orthodontic movement and TMJ is ideal. The goal is not just straighter teeth, it is to get a healthy stable outcome for lasting results. Some outcomes with Inivisalign® can be less stable than they would be with traditional braces, which increases the need for fixed retention, such as wire bonding on the lower teeth or the use of retainers indefinitely.

Invisalign does allow business people to straighten their teeth and not have their image/business savvy interfered with because they can communicate well with Invisalign®, and most people can not even tell you have anything on your teeth. One of the big benefits we see from a dental standpoint is that you can straighten your teeth but still remove these things, brush and floss your teeth, and still keep them very healthy. With traditional braces you can not clean your teeth as well and it holds stuff against your gums. Many individuals with traditional braces end up with inflammation of the gums and discolored teeth from the pressure of the braces. Invisalign® has big advantages in that it uses the most modern Cad/Cam technology. This is where the dentist can view your individual case using a computer program that helps to guide how the movements in the teeth are made. An individual plan can be made that is tailored for optimal treatment for each patient.

For over 25 years dental implants have provided a natural looking solution for replacing missing teeth and for stabilizing or anchoring dentures. Before placing the dental implant into the jawbone, an analysis is taken to determine how the upper and lower jaw functions together. In addition, photographs, x-rays, and molds are taken of the teeth, smile, mouth, and jawbones.

Based on the analysis, we develop a plan that is in harmony with the patient’s goals and desired outcome. Most commonly, the patient’s goal is to replace their missing teeth, to use implants in place of their partial dentures, or for use with their dentures to create stability when chewing.

Some implants need time (four to six months) to fuse to the jawbone so that they will be strong enough to hold the crowns, bridges, or dentures. Implants usually require a surgical and restorative phase, but in some cases they can be used almost immediately after placement in the jawbone.

Typically, dental implants replace the roots of the missing teeth in the bone so that whatever attaches to it will be more stable. Individuals who have lost many of their teeth, if they have enough bone, have many options for stabilizing and making their dentures more functional with implants. Implants can also be used to build fixed bridges attached in part of the mouth, which is more like replacing teeth that the patient can really bite with. The advantages of putting in implants underneath the denture is, in addition to support, it stimulates the health of the bone and keeps it from resorbing as it does when it has a denture placed on top of it. One of the problems we have is that when the teeth are taken out, the bone begins to shrink down as it responds to the pressure of the dentures.

Over years of wearing dentures, the bone continues to shrink and eventually the dentures do not fit the mouth. Implants slow down this process dramatically by stimulating the bone to stay healthy and keep it from resorbing. The dentures will last longer because the underlying areas of the bone are healthier.

If you would like to learn more about implant dentistry to see if it is the best option for your goals for oral heath and beauty, please contact our office to schedule an evaluation.

We have become passionate about learning more about dentures over the past several years. Early in our dental practice we saw a new patient who was in her thirties and had dentures since she was sixteen years old. She had absolutely no bone left and could not wear her dentures. Back then we did everything that was known at the time to help her and this sent us on a quest as life-long students in dentistry. In today’s dentistry we have better answers, but at the time she was still unable to chew with her dentures. Our newest technology gives us options such as bone grafting, implants, and other stabilization. However, if a patient loses their teeth and simply puts plastic over the gums, they are going to be orally handicapped. For this reason, we do the best restoration that we can that is functional and aesthetic. This approach makes the patient look like they should look if they had their original teeth. That was a problem for most dentures in the past because, as the lower jaw shrinks, the neutral zone between the tongue and lip moves back. To keep your denture from having this constant movement of being pushed back and up, you couldn’t support that lower lip like you normally would. That’s why so many people with dentures look older-because they are not supporting the lips plus they wear them way to long and the jaw is over closed. As the jaw is over closed then you get the “Andy Gump” look where the chin almost meets the nose.

Veneers can help improve the size, shape, and color of the teeth. They are thin layers of porcelain that bond to the outer edges of the teeth. Because they rely on the underlying strength of the tooth structure, veneers are not the right solution for all patients.

Veneers are not always the solution.

When a patient seeks out help for worn teeth, far too often the decision is to simply use veneers to lengthen the teeth back out. The problem with simply adding veneers onto the teeth is that it is important to find out why the teeth were shortened in the first place. Simply lengthening the teeth back to where they were may only treat the effect because it does not solve the underlying cause of why the teeth wore down in the first place. This sets the patient up to potentially wear down or break their veneers, just as they did with the teeth the first time. Often it is necessary to reposition the teeth or deal with another problem the patient may be having, such as grinding their teeth at night. If they have veneers placed, they may want to use a night guard to protect the teeth from damage as a result of grinding.

Addressing the Underlying Problem.

Before deciding to use veneers, we carefully examine the underlying problem. We determine whether the problem is skeletal, just the teeth, or the bone that supports the teeth itself in order to truly solve the problem. We also provide you with the options that are available because veneers are a big investment and they are not really reversible. So if the patient has problems with them, they just have to keep replacing them. We make sure that the patient’s gums are in the proper place and that they are not showing too much gums when they smile because their teeth have worn, erupted down and brought the gums with them. We also ensure that the gums are even to assist with a beautiful smile because putting veneers on them does not solve that problem if the gums are not addressed.

If the front teeth are tilted back and in, that is an abnormal relationship that leads to wear and if veneers are put on those type of teeth, the same wear will happen over again only now they will have to pay for the veneers over and over again.

Far too many times veneers are the answer that is given because the patient requests them or the dentist does not properly assess the entire situation. For example, sometimes veneers are put on when the answer really needed to be repositioning of the teeth prior to restoration. If the teeth are properly positioned, that makes room to ensure that the veneers are the appropriate size for the patient. If the teeth are restored in an abnormal position that has taken place because of wear the teeth, the veneers can not be the right width to length ratio for that patients smile…and may not be in the right place in that patient’s smile.

There are negative effects to getting veneers before restoring teeth. The patient may feel discomfort, such as jaw pain. In most cases, there will simply be a problem of maintenance. The patient may break off, chip, or wear down the veneers just like they did with their natural teeth.

A lasting Solution

If the teeth are restored correctly in the proper place, the patient can look forward to increased longevity, increased comfort, and a very beautiful smile as a result. Simply making teeth bigger with veneers often times does not solve the core problem and does not give the patient the best smile that is possible. Although it may offer improvement, it will not give the final result that could have been accomplished. Far too many people get veneers and feel semi-happy with them because it is an improvement over where they were, but they are so far from where they could have been for the final outcome.

Some symptoms of worn teeth include chipped teeth, your teeth do not show when you smile, or if you feel that your smile is flat and unattractive.

Veneers are not always the solution.

When a patient seeks out help for worn teeth, far too often the decision is to simply use veneers to lengthen the teeth back out. The problem with simply adding veneers onto the teeth is that it is important to find out why the teeth were shortened in the first place. Simply lengthening the teeth back to where they were may only treat the effect because it does not solve the underlying cause of why the teeth wore down in the first place. This sets the patient up to potentially wear down or break their veneers, just as they did with the teeth the first time. Often it is necessary to reposition the teeth or deal with another problem the patient may be having, such as grinding their teeth at night. If they have veneers placed, they may want to use a night guard to protect the teeth from damage as a result of grinding.

Addressing the Underlying Problem.

Before deciding to use veneers, your dentist should carefully examine the underlying problem. They should determine whether the problem is skeletal, just the teeth, or the bone that supports the teeth itself in order to truly solve the problem. Your dentist should give you the options that are available because veneers are a big investment and they are not really reversible. So if the patient has problems with them, they just have to keep replacing them. They should look and make sure that the patient’s gums are in the proper place and that they are not showing too much gums when they smile because their teeth have worn and they erupted down and brought the gums with them. They should make sure the gums are even to assist with a beautiful smile because putting veneers on them does not solve that problem if the gums are not addressed.

If their front teeth are tilted back and in, that is an abnormal relationship that leads to wear and if they put veneers on those type of teeth, the same wear will happen over again only now they will have to pay for the veneers over and over again.

Far too many times veneers are the answer that is given because the patient requests them or the dentist does not properly assess the entire situation. For example, sometimes veneers are put on when the answer really needed to be repositioning of the teeth prior to restoration. If the teeth are properly positioned, that makes room to ensure that the veneers are the appropriate size for the patient. If the teeth are restored in an abnormal position that has taken place because of wear the teeth, the veneers can not be the right width to length ratio for that patients smile…and may not be in the right place in that patient’s smile.

There are negative effects to getting veneers before restoring teeth. The patient may feel discomfort, such as jaw pain. In most cases, there will simply be a problem of maintenance. The patient may break off, chip, or wear down the veneers just like they did with their natural teeth.

A lasting Solution

If the teeth are restored correctly in the proper place, the patient can look forward to increased longevity, increased comfort, and a very beautiful smile as a result. Simply making teeth bigger with veneers often times does not solve the core problem and does not give the patient the best smile that is possible. Although it may offer improvement, it won’t give the final result that could have been accomplished. Far too many people get veneers and feel semi-happy with them because it is an improvement over where they were, but they are so far from where they could have been for the final outcome. Sometimes finding the right solution requires a comprehensive approach from a group of qualified, dental specialists who work together with the patient’s best interest in mind. The end result is rewarding: optimal aesthetics and longevity.

There has been a lot of progress made in the area of filling materials for teeth for small areas of decay. Previously, silver imogen was the major choice for dentists. One downside of these silver fillings is that they are held in mechanically so the dentist has to undercut the preparation to get it to lock in to the tooth, resulting in the removal of good tooth structure to get it to mechanically lock in to the tooth. Because they did have to make a larger opening to put in a silver filling, dentists were many times reluctant to fill the smaller cavities, waiting until the cavities were bigger to put in bigger fillings. The bigger a silver filling gets, the more discrepancy there is in the coefficient of expansion. This means the metallic filling will expand and contract more than the tooth structure it is in when making contact with hot and cold foods. When this happens over an extended period of time, often times the teeth will crack or the margin between the filling and tooth will break down, causing leakage. The biggest problem found with baby boomers who received these big silver fillings when they were young, is most of them needed crowns as they grew older. So now there is a push to perform less invasive dentistry and the composite resins have come a long way from previous generations. The composite tooth color restorations wear more like tooth structure now and they bond to the tooth so the dentist doesn’t need to rely on undercuts. This allows us to remove just the decayed area itself and bond the filling into the tooth, preserving more structural integrity to the tooth.

Because we are taking care of decay at an earlier stage and using filling that bond to the tooth that have a coefficient of expansion that is more similar to the tooth structure, there are fewer cracked teeth caused by the restoration, the fillings are smaller so they last longer, and cosmetically they blend to look more like part of the teeth.

When fillings get to be a certain size, regardless of the material, you are exceeding the limits of that material for it to be an effective restorative product. In this case, porcelain restorations can be shaped and cast to fit in or on the tooth and bond to the tooth. This solution can be effective for teeth that need full coverage to protect where they have been cracked or broken. Often times now we don’t have to do a full crown when we can do different shaped restorations that bond to the teeth and maintain more structural integrity to the tooth.

A large number of people do not have room for wisdom teeth. This may be the result of an evolutionary change because our diet has changed over thousands of years and we don’t eat as many greens and nuts and our jaws are not as big as they used to be. We are seeing more and more people in the past few generations did not even form some of their wisdom teeth. Those who do have wisdom teeth and don’t have room for them will get impacted teeth. When a tooth becomes impacted it can do damage to the tooth in front of it. Depending on how it’s sitting in the jaw bone(or what happens in most cases) the wisdom tooth will come part way out of the jaw and then the gum tissue surrounding the enamel covered crown of the tooth can’t adhere to the enamel and a pocket forms. Food can get trapped in the pocket and cause an infection caused periocornitis. This infection causes swelling and pus from around the wisdom tooth that will come and go but become more frequent and severe over time. Quite often it is necessary to remove those wisdom teeth and, in many cases, it is a surgical procedure to extract the tooth.

In our office, we provide IV sedation so that the patient isn’t aware of the treatment while it is going on, and will recover better than with just using a local anesthetic. Taking out wisdom teeth is sometimes an elective thing but it is usually best to do it when the patient is younger before the bone becomes dense. Early extraction also gives less likelihood of the wisdom teeth causing damage to the other teeth, caused by the patient’s bite or resorption of the tooth in front of it. If extraction of wisdom teeth is ignored and it is growing into the molar in front of it, the patient may get almost like decay but its resorption similar to the resorption you get when permanent teeth come under the baby teeth and resorp the roots. Sometimes if you ignore it, you will end up losing multiple teeth: the wisdom tooth and the one in front of it, and then the one above it because it doesn’t have a tooth to function against. For these reasons, extraction of wisdom teeth is an important thing to evaluate at an early stage.

A large segment of the population does not seek proper dental care because of fear. Today there are several options that make dentistry much more comfortable. For years nitrous oxide has been available, which is an analgesic gas that raises the pain threshold and alleviates anxiety. This is a good solution for many patients and the gas is out of the system within just a few minutes of breathing oxygen afterwards, so a designated driver is not necessary after treatment.

Some individuals are reluctant to even just have their teeth cleaned because of fear. For these individuals we have oral medication that can be taken 45 minutes to an hour before their appointment that will alleviate their anxiety. The medication is strong enough to really do an effective job so these patients will need a designated driver after treatment.

If we are going to be doing significant dentistry on an individual who is not comfortable sitting for an extended amount of time or has an extreme fear, IV sedation is available. This is a safe method of sedating the patient so that they will not have an unpleasant memory of the treatment. They will not be unconscious, as with general anesthesia, so there are not extreme dangers associated with this sedation. Patients can still respond and inform us if something is bothering them so that we can respond accordingly.